Background

Increase in bariatric procedures and longer follow up revealed many patients with weight regain and relapse of comorbidities. An option for restrictive procedures (sleeve gastrectomy/ gastric banding) is conversion to Roux en Y gastric bypass. Data on efficacy of revisional gastric bypass in terms of weight loss and control of metabolic disorders associated with obesity are limited and controversial. We compared patients who underwent primary vs. revisional gastric bypass in terms of: weight loss, and diabetes resolution/ improvement, hypertension and dyslipidemia rates.

Methods

Retrospective comparative observational study of primary (120) vs. revisional gastric bypass patients (40) at HMC (2011 – 2014) who had diabetes, hypertension and dyslipidemia. Patients’ data were retrieved from inpatient and outpatient charts, electronic medical records and bariatric patients’ database. For T2DM, data included: fasting blood sugar, HbA1c, number of diabetes medications used, insulin use before and after surgery. For hypertension: BP records, number and medications used for treatment of hypertension before and after surgery. For dyslipidemia: cholesterol, triglycerides, HDL, LDL. For weight loss: %EWL, %TWL, and delta BMI.

Results

There were no differences in age (40.93±10.4primary vs. 42.18±8.5revisional years), gender (83 femalesprimary vs. 33 femalesrevisional) and preoperative BMI (45.90±6.64primary vs. 46.53±11.96revisional). Among diabetic patients, there was no statistical difference in terms of DM status and medication use pre and post surgery except for insulin use where there was significant improvement in the primary group (p =0.024). Among hypertensive patients, there was no statistical difference in terms of hypertension status and medication use pre and post surgery. Among dyslipidemia patients, there was no statistical difference in terms of dyslipidemia status pre and post surgery. However, we observed statistically differences in favor of primary gastric bypass in terms of %EWL (69.99±23.6primary vs. 49.41±27.0revisional, p < 0.0001), %TWL (30.60±10.3primary vs. 21.20±11.8revisional, p < 0.0001), delta BMI (14.23±5.8primary vs. 10.69±7.5revisional, p = 0.003).

Conclusions

Although revisional Roux en Y gastric bypass did not add significant weight loss to primary restrictive procedures, it still had the same rates of resolution of obesity related comorbidities as primary gastric bypass.